Priory Supported Living Kent remained Good overall, providing safe, effective, caring and responsive support to people with learning disabilities and autistic people across four supported living locations. Well-led remained Requires Improvement due to shortfalls in care plan detail, risk assessment guidance, PEEPs and recruitment record keeping, although culture and management oversight had improved.
Concerns (8)
moderate
Record keeping
: “Some documentation lacked information and specific detail. Although this did not have a direct impact on people there could be a risk staff that were new or unfamiliar with people would not have the guidance”
moderateCare planning: “Care plans were cumbersome and contained a lot of information that made it difficult for staff to easily find the relevant information they needed.”
moderateGovernance: “the risk assessments did not include full step by step guidance for staff on what action to take if the risks occurred. For example, if someone started to choke or had a seizure.”
moderateRecord keeping: “Personal emergency evacuation plans (PEEPs) did not include specific information to instruct staff on how to support people in an emergency.”
moderateSafeguarding: “there had been a safeguarding incident which had not been reported immediately to the registered manager. This caused a delay and meant action to keep people safe was delayed.”
minorGovernance: “Recruitment records were not all kept together. One staff recruitment file only contained one reference; the other reference was at the providers central office.”
minorMedication management: “There had recently been a medicines error. This was fully investigated and the reason for the error identified.”
minorComplaints handling: “the meeting in September 2022 had identified that complaints were not being recorded well although staff were responsive in resolving any concerns people had.”
Strengths
· Enough staff to meet people's individual needs with safe recruitment checks
· Staff knew safeguarding processes and people reported feeling safe
· Medicines managed safely with regular audits and oversight
· Effective infection prevention and control measures in place
· Staff received training, regular supervision and annual appraisals
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Working in partnership with othersRequires improvement
Focused inspection of Priory Supported Living Kent found the service safe but well-led had deteriorated to Requires Improvement due to inconsistent management, a 'toxic' staff culture, and unsustained responses to professional recommendations. Overall rating remained Good, with a new manager in post working through an improvement plan.
Concerns (7)
moderateLeadership: “The management of the service had been inconsistent... managers had not always been responsive to concerns raised.”
moderateGovernance: “where recommendations had been made by professionals, these had either not been implemented or where they were, had not been sustained.”
moderateCommunication with families: “health and social care professionals who work with the service told us the communication and responsiveness from the service was poor.”
moderateSupervision / appraisal: “Staff told us supervisions and one to one meetings were not as regular as they could be and at least one supervision had been done by a peer, rather than a manager.”
moderateOther: “Staff told us the culture of the service within the staff team was poor, using terms such as 'toxic', 'hostile' and 'bullying'.”
minorStaffing levels: “The service had a high turnover of staff and new staff had joined the service recently. The service still had vacancies for support staff”
minorIncident learning: “The service had systems in place to encourage lessons to be learned and shared after incidents or accidents, but this wasn't always robust enough”
Strengths
· Staff knowledgeable about safeguarding and people reported feeling safe
· Comprehensive risk assessments and person-centred support plans
· Safe medicines management with monthly audits and competency assessments
· Effective infection control measures including COVID-19 procedures
· Safe recruitment practices including DBS checks
Quality-Statement breakdown (11)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements
Not rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated